Forms to Get Started

This is the first step. Complete this form to inquire about our service availability. After reviewing your information, we will contact you with details about available service options, answer questions about services, and let you know about any wait times for the service you are requesting.

These forms are secure and will "self-submit" to our office automatically after you complete them.  

• Referral/Request for Services

Needed before scheduling an assessment with our Clinician:  

• Demographics and Insurance Form

Please complete and submit the following forms at least one business day before meeting with the BCBA.

• Service Agreement and Declaration of Professional Practices

• School/work and medical information

• Skills and Behavior Information

• Home information

• Consent for assessment and telehealth

If you wish for a professional to share information with us or for us to share information with another member of the treatment team, please complete the following:  

• Authorization to Release Information